Cat not responding to Glargine Insulin

Hi. I'm new here. I don't have ready access to any vet other than one that can do simple things. Diabetes is WAY out of his league. I suspected Blackie had diabetes for a long time... but for various reasons I won't go in to, I held off confirming it. He was eating fine and peeing fine. Until 2 weeks ago. Then he started drinking water like a fish. That was when I got concerned. Blackie is a rescue American Shorthair. We are not sure of his age but I suspect around 16 years. He has been a beloved member of our pride for 7 years now. He has always been heavy. He weighs 24 pounds right now. I mostly feed him raw ground chicken breast with raw eggs and other goodies of various types of vitamins in it. I do not freeze the meals. One chicken breast vacuum packed will last a long time in the fridge. I live in Southern Ecuador and while there is access to Insulin, there is not ready access to vets and I am struggling with the language as it is. I took Blackie down last Wednesday for a blood draw, and here we can take our own blood samples in to the lab and they will test for animal or human. I took over a fresh sample of his pee and his blood. His mg/dl was 420 - he had also eaten the high protein breakfast about 2 hours before that. I got insulin and started him on it the next day at 1 unit, .25 on the 100IU syringe. There has been no change to his mg/dl except that it has gone higher on that dose. I upped it to 1.5 units starting last night. I give it 2x a day. I tested his blood with my newly purchased glucometer this morning before feeding him....... 505 mg/dl. I checked it again at 3pm and it was 419 mg/dl. There is no way I can get any other kind of insulin for him down here.

I am thinking of raising the dosage to 2 units a day starting tonight. My feeling is I have waited too long to treat his diabetes and I might be too late as he appears to not be responding. Since he weighs 24 pounds, maybe 4 units a day would be what he needs to start bringing it down to the 250 - 300 range. If I could get it in that range I would feel really happy. Maybe American Shorthairs are more prone to diabetes?

LIke I said earlier, I do NOT have a vet to consult about this treatment process. I am on my own. I do have a WA State number down here thanks to Magic Jack. So if anyone feels inclined to call me it is 360 567 6178. We are on Eastern Time Zone.

 

I do not understand what you mean by " 1 unit, .25 on the 100IU syringe."?
What capacity insulin syringes are you using? U1100 insulin syringes come in:
- 100 unit/1CC capacity. Those are marked every two units
- 50 unit/1/2 CC capacity. Those are marked every unit
- 30 unit/3/10 CC. Those are marked either every unit or every half unit.

How long on the one units?. It can take the body 3-5 days to build up Lantus/Glargine to see consistent effect.
Can you post the BGs in relation to when the shot was given and when fed.
For example, the BG right before show would be either AMPS pr PMPS. BGs in between would be +X BG where the X is hours after shot and BG is the measured BG

 

Thanks for your reply. I started on the 100 unit /1CC syringe and only gave .25 of the 1 unit measurement. Then thanks to the advice of some great folks here, I searched for the 30 unit/3/10 cc syringe. I have been using that one now for 2 days. On that one I give up to the 1st 1/2 mark 2x a day. It's been 6 days - tonight will be the end of the 6th day.

 

Clarification... it's been 2 days on the 1 unit 2x a day. So maybe give him 1Unit through tomorrow and if he still has super high readings, up it on Thursday morning?

 

0.25 of the first marking on a 100 unit syringe is 1/2 unit.
I would increase to 1 1/2 units Thursday if you do not see an improvement on 1 unit

 

Hi Heidi and extra sweet Blackie!

Lantus (glargine) takes 5-7 days before you will really know how it's working (when you first start). If I'm counting right, it looks like Blackie has been on it for 6 days?

Do the syringes you were able to buy (the 30 unit ones) have half unit markings? We usually only make changes in dose of .25 to .5 unit so it helps to have the half unit markings.

We have a great spreadsheet that will really help us to help you determine how Blackie is doing. Here are some instructions on Setting up a spreadsheet. If you have trouble with it, let us know! We can get it set up for you and then transfer it to your name to continue entering data.

There are 4 tests that are really important. Testing before every shot (the Pre-shot) test to make sure they're high enough to give insulin, and then at least 1 test at +5 to +7 during the AM cycle, and a "before bed" test on the PM cycle.....+5 to +7 is 5 to 7 hours after the shot....we use the + system here since everyone is in different time zones. We need to know how low each dose is taking him, so we're looking for the "nadir" (the lowest point in the cycle) which is usually about 6 hours after the shot, but varies from cat to cat. Of course the more tests, the better! There's no such thing as too much data!
You say you tested at 3pm....how many hours after the shot was that? (for example, if you shoot at 9am, 3pm is +6)

It's important that you give the same dose every 12 hours for at least 3 days now so it has time to really see how it's doing, and get at least those 4 tests in. We can help guide you on dosage from now on so you don't have to worry about dealing with a vet. You're actually very lucky to be able to get Glargine! It's one of the best insulins for cats!

If you have any questions, please ask! The people here are great!

Edited to Add...Here are some pictures of doses.....The 6th picture shows 1 unit and the 7th picture shows .5 unit....I'm still not quite sure what dose you're giving. Syringe pictures

 

hi heidi!

how is Blackie behaving? is he acting fairly normally, or sickly? the drinking excessively and eating a lot is normal for any unregulated cat, but other than those, how does he seem?

You have to go slow with adjustments of Lantus, but you may have started at too low of a dose for such a big boy. His 24lbs = 10.9kg and the formula for starting with Lantus is 0.25u/kg of the cat's IDEAL weight. What weight do you think he should be at? If his ideal weight is 12lbs (5.5kg), that would be a starting dose of 1.375, so we'd suggest you start at 1.25u per shot.

Take a look at the Tight Regulation Protocol page - look about 5 paragraphs down for the PDF that is called "Management of Diabetic Cats Using Long-Lasting Insulin." It's the latest publication of the protocol that we use to treat cats. (you don't need an AlphaTrak, however, we "speak" in human glucometers.) The premise of tight regulation is that if a newly diagnosed (less than 1 year) cat is kept "tightly regulated" meaning that their blood sugar is kept in normal range (50-120), their pancreas has the ability to heal and the cat may be able to go off of insulin and be just diet controlled. That's a pretty powerful incentive for most people to give it a try. Even people who work find ways to get enough tests in to try to get their cat tightly regulated.

If you're interested in that, as soon as you get a spreadsheet set up, i'd encourage you to post to theTight Regulation Insulin Support Group and we can coach you in what you need to know to manage Blackie. We rely heavily on the spreadsheets - individual numbers don't mean as much as numbers in context, both relative to when the cat last ate, and what the rest of the numbers are in the past 3 days. So if you can use the link that Chris gave you and get his numbers on the spreadsheet as best as you can, that would be awesome.

Sometimes numbers are high because the cat's blood sugar has gotten low and the body has reacted to a perceived hypo. It doesn't need to have gotten into a dangerous range - if his body has gotten used to 400's and he gets to 200's, his liver might react to send him back to 400's. When we see his numbers on the spreadsheet we can tell if that's happening or if he needs more insulin. That's why it's important for us to see his numbers in context on the spreadsheet. If you need help with that, just say so. There are people who can help you set it up - just say so if you're having trouble.

The raw diet is great! You don't need to change his food.

He's awfully heavy - i don't think American Shorthairs are prone to diabetes, but his weight may be a problem. Cats need to lose weight VERY slowly, though, so don't just take off with that yet.

Sounds like you've got the right syringes now. Consistent dosing is important with Lantus, so you may want to keep a used syringe with colored water (tea?) in it to show the dose. If you don't have 0.5u markings, then the comparison syringe is even more helpful.

what glucometer are you using?

Make sure you have a hypo kit put together, just in case you need it. Here's a link to the New to the Group? yellow starred sticky that will have lots of good information. At the bottom of that page is a link to what should be in a Hypo Toolkit. When you've gone through it and the TR page, also look at Lantus & Lev, Info, Proper Handling & Storage. Lantus needs to not get contaminated, so you want to watch the video on that page and read the info so when you draw up Blackie's dose, it keeps the Lantus from getting contaminated. If you take care of it, it should last for several months.

so - i hope i haven't overloaded you!

---lots of reading - you don't have to memorize it, but just take a look.
---get a spreadsheet or ask for help if you have trouble.
---and tell us what glucometer
---how much you think Blackie should weigh
---let us know how he's behaving/feeling.

Keep asking questions and we'll do our best to help you. We do diabetes 24/7 - we can teach you what you need to know to help Blackie, even in Ecuador! We have members all over the world here. Welcome!

There's often someone online here - we can help you with managing his insulin dosing. You won't need a vet for it.

 

This is important as I am seriously getting confused on the dosages: the first 1/2 mark on the 30Unit/3/10cc is actually 1/2 a unit for people. For cats, isn't it just over 1 unit in the U-40 measurement conversion? I thought 1 Unit of people Insulin equaled 2.5 Units for cats? Or are we measuring it simply as human units for simplicities sake? Meaning, when it is said that cats usually start out at 1 Unit, is that one HUMAN Unit or do we convert the unit to the U-40 Insulin measurement and adjust the dosage using a U-100 syringe accordingly? I have been giving him up to the first .5 mark or a little over on the 30 Unit 3/10cc U-100 syringe. If I move the dosage up to the 1 mark is that not 2.5Units in U-40 conversion? The U-40 vs U-100 and the number of units to use for the cat with the U-100 syringe is what is confusing me.

If the first .5 mark on the 30 Unit U-100 syringe is what we call a .5 unit for Blackie, then I have not given him enough as I have only gone just slightly over that so far, thinking that the .5 mark was actually just over 1 Unit for cats. Jeesh. I went to the link Chris and China White gave me and now I see that I need to throw out my U-40 thoughts and just measure in people Units. So tonight, I will give Blackie up to the 1 Unit mark on the 30 Unit 3/10cc syringe. aye yai yai. I was never good in Biology lab either.

Here is the link to my spreadsheet: https://docs.google.com/spreadsheets/d/ ... 1896019009
I could not figure out how to change the link to just "Blackie". I couldn't find the control panel on the spreadsheet page. Also, the first few days I gave him insulin, I didn't have a Glucometer to measure. So the chart starts at 3 days ago. There is nowhere to put when feeding time is that I can see, so I put it in the remarks. I will keep practicing and hopefully get the knack of it soon.

I have goofed on the insulin dosage as I have given him at the most only 1 unit so far. Tonight I will give him 2 units. I go to bed really early, so won't be able to test the after affects of the 7pm'ish shot as testing 1 hour after that is silly. Daytime will have to be it for me, at least for now, until I can teach my husband what to do, as he stays up usually until 10ish.

Blackie also tested with a bacteria infection. Today is the end of a round of antibiotic for 7 days. He has perked up the last couple of days a bit, probably due to the infection being gone. He always has been a very lethargic and slow moving cat right from the day we rescued him. He always has been large but has gained about 8 pounds I guess, since we rescued him in '98 off the road. He is a very muscular, stocky cat, so it's hard to say what his lean weight would be. Probably 18 pounds? He has better days, where he is a little frisky and playful, but most of the time he just trundles slowly around and loves to cuddle. He has always had bad dandruff on his back... probably from long term diabetes? I add olive, coconut, wild alaskan salmon oil, and raw butter when I make his food so he gets plenty of oils. Maybe this will recede if/when the insulin starts to bring down his BG.

I am using an Accu-Chek Perfoma Nano glucometer, it's what the best pharmacy here in Ecuador recommended, after researching online, I fear it is an older model but oh well, I did the best I could at the time. It seems to work fine. I take my BG too for practice.

I have downloaded the Management of Diabetic Cats PDF and will read it when my brain un-freezes from all this other stuff today!!

I figure ANYTHING I do for him will be a help as long as I follow instructions. I am excited to see if 2 units will get his body to respond. I might even get up in the middle of the night tonight just to test him.

Thank you thank you thank you all!

 

Please do NOT give 2 units tonight, if you've only been giving 1 unit so far. That's too much of an increase. If you already did, please try to get some tests in! We don't want Blackie going too low!

We don't EVER increase dose in whole units...Usually we go in .25 or .5 unit increments.

Glargine is a U100 insulin (at least it is in the rest of the world) so you should be using the U100 syringes and measuring just like human doses. 1 unit is 1 unit

Don't worry about changing your spreadsheet link to read "Blackie"....as long as the link is there, that's all that counts

Tests you need to get:

ALWAYS before giving insulin....that's the AMPS and PMPS tests (AM Pre-Shot and PM Pre-Shot)
During the AM cycle, at least 1 test somewhere between +5 and +7 (5 to 7 hours after the shot)
During the PM cycle, at least a "before bed" test (just in case he's going too low and you need to set an alarm to wake up for more tests)

We can help you get Blackie better controlled...it's just going to take a little time and patience!

Edited to Add...what you can do to help us out is put some information in the "Signature" block (like where you see our information below this post) You just go to the top left side of the page and find the "User Control Panel". Once there, you go to "Profile" and then "Edit Signature"
A new little box comes up and you can add:
Your name & cats name
Diagnosis date (if you know)
type of insulin
type of meter
Food you're feeding
Any other health problems
The Link to your spreadsheet!!

Then just hit "submit" and we won't have to keep asking those same questions over and over again!

 

Ok. Updated signature block. Thank you.
Ok. Just checked PMPreShot - 445. Blackie ate a lot one hour ago. Giving 1.5 Units at 7pm Insulin is warming up right now.

I will check another blood test before I go to bed in a couple of hours.

 

I'm not sure why, but your spreadsheet link isn't working

Try going back to your signature again and Click on the URL tab and then "paste" your link in between the Your link here[url] and then "submit" again I think that might be the problem

 

Ok. URL added. Thank you.

 

i can see your spreadsheet - good job getting the link fixed!

the insulin issue is confusing - i actually had a similar situation when i started, because i started with ProZinc, which needs u-40 syringes and then switched to Lantus, which needs u-100 syringes.

it's not that they are pet or human insulins, although they are, it's how concentrated the insulin is. You want to match the insulin concentration with the syringes that are made for that concentration. For the sake of simplicity, let's just talk in u-100 units, because you're using Lantus and you're using the correct syringes (u-100) now.

Now that you're at 1.5u, stick there for 6 shots total. Lantus works best with consistent dosing, so it's helpful to try to be consistent in the dose unless you have a reason to change it. I look at the guideline about starting Lantus a little differently - i don't think that staying at 5-7 days is necessary in every case. These are guidelines. If Blackie remains high, i would suggest that we increase him after 6 shots total at 1.5u. It's not good for him to stay high like this any longer than necessary.

If you are confronted with a preshot number of less than 200, please hold off on feeding or shooting him and post here or on the Lantus/Lev Tight Reg forum to ask for help on how to proceed.

You're doing great getting tests in! A +1 isn't necessary at this point, but it's not silly and at some point you'll want to get some tests then. A +1 tells us if a cat's blood sugar spikes (goes up) from the carbs in the food. Some cats do and some don't - but it's important information to have. For the moment he's just high, but our goal will be to get him into normal numbers, assuming you want to try for remission (do you?) A great way to look at the spreadsheet is to consider it a jigsaw puzzle. You don't need every piece of the puzzle to see what the picture is, but if you have enormous blank areas, you may have trouble deciphering things. We encourage people to get a variety of tests in.

Initially my husband didn't do much with punkin's blood sugar care. I had him help me hold punkin still while i tested or shot, but as time went on, he tried testing first and then eventually shooting. Before long he was 100% involved in all of it - which gave me some much-needed freedom! Perhaps if you can get your husband to just watch you and hold Blackie still, he'll eventually move to being more involved.

Your meter is fine - i'm not familiar with that exact model, but Accu-Chek is a good brand. Putting eating times in the comments section on the right of the spreadsheet is perfect. thank you!

It's helpful to have any background information, especially health-related, on a profile, or on the spreadsheet. I'm unclear on exactly what date he started insulin - even if you have no tests, would you put it in as best you can on his spreadsheet? For a profile, you can just use a google doc and then attach it to your signature as Chris suggested, just like you did with the spreadsheet. If you want an example of what we're looking for that is helpful, take a look at the profile for punkin that is in my signature line. We just want all the background in one spot - it's very helpful when we're giving you advice.

For example, the weight gain you described is very important. Has he lost any weight since becoming diabetic? or has he continued to gain weight even while unregulated? His body shape that you described is also important. The infection that coincided with the diagnosis is important too. Infections can increase blood sugar. It would be great to include the info on the antibiotic (what AB and what dosage?) in the comment section too - sometimes blood sugar can really come down when the antibiotic kicks in.

Yes, dandruff and icky hair go along with high blood sugar. that will improve as he gets regulated. Great idea to include the oils in his food - that will help too.

ok - so to summarize:

- a profile page with medical info attached to your signature is super helpful
- stick with 1.5u for 6 shots total for the moment
- get some random tests in - i actually like the +2/+3 tests (2-3 hrs after each shot)
- if you get a preshot test of 200 or less, don't feed him, post here or on the TR forum and ask for help

you're doing great. The learning curve on Feline Diabetes is very steep. We all get it - it's very hard at the beginning and an overwhelming amount to learn. it gets infinitely easier as you learn more! keep posting here and asking as many questions

 

One more quick "rule" ....We don't want you to feed for the 2 hours prior to Pre-shot tests, so we know the number isn't influenced by food, so take any food up after +10 so that when you do your pre-shot tests, they're as accurate as possible.

I see on your spreadsheet that you fed at 6pm and then tested/shot at 7pm. That means that his PMPS was going to probably be higher than it would have been if he hadn't just eaten.

Generally, we test/feed/shoot all within about 10 minutes. Test to make sure they're high enough to give insulin, feed to make sure they're going to eat for you, and then shoot the insulin.

 

In a perfect world, but doesn't really work in the real world if I am going to keep the insulin shots 12 hours apart. Sometimes he is feeling ill and won't eat when it time for the shot. I have resorted to giving him a few Greenies when that happens. Sometimes he is hungry between. This morning his BG at 7AM was 551. I fed him and then shot him.

I don't think I can get him off insulin as he is old and has probably had diabetes for a long time. Maintenance is my goal.

I have two other cats. The night time is the time when everyone is more active and eat the dry food in the wee hours. I guess I could pick it up if/when I get up to pee around 2/3am. IF Blackie eats, like he did this morning, it means he did not eat any dry food as if he had, he wouldn't have eaten so much wet. So this morning, I KNOW that the 551 reading was not influenced by him eating between 5am and 7am. In the day time, Blackie doesn't even go near the dry food. He prefers his yummy homemade raw chicken meat with all kind of yummies added.

I still think I should increase his dose tonight to 2 units. He is simply not responding at all to the lower dosage. With his readings not getting below 400 in the past week, since I started all this, I highly doubt increasing to 2 units will put him into a hypoglycemic response.

Re Julias response below... Ok. I will dose 1.5. It is most likely that Black Bear has had high blood sugar for a very long time, so having it a little longer probably won't hurt him any more than it already has.

 

I would not increase the dose yet. Lantus needs consistent dosing for it to work--it can take up to 72 hours to see the effects of a dose. If you raise the dose too quickly, you end up with blood sugar just as high as if you have too low a dose. Most cats do not need much more than 1u of insulin; I would stick to 1.5u for at least 3 days before you raise the dose.

Hypoglycemia is a very real danger, and I would urge you to be cautious. It's better for your cat to have high blood sugar for a few days than to drop too low for even a minute. Also, raising the dose too quickly is counter-productive. Again, too much insulin will leave blood sugar just as high as too little insulin. Lantus requires a bit of patience.

 

Heidi, i just edited my previous post because i said that ProZinc used u-40 syringes and then i switched to Lantus, which uses u-40 - NOT. Lantus uses u-100 syringes. Sorry about that! Sometimes you get typing and . . . well anyway, you've got the right syringes now.

You just gave a huge clue in your last post as to why Blackie's numbers don't seem to be responding. The dry food that's available. Some cats are carb sensitive and even a few kibbles, literally 5 crunchies, will send their blood sugar high and keep it there. I'm going to pull a spreadsheet for you for a cat that lived in a house with 13 kitties total. The mom was certain he wasn't eating any dry food, but when she got rid of the kibble for the entire house, he went from 5.5u to off of insulin in 2 days.

Look at Scooter's spreadsheet here - notice the difference between the colors of the spreadsheet above 2/18 and after. Yellow-Pink-Red-Blacks are numbers that are 200 and over. Blues and greens are 100's and less. The non-diabetic cat runs somewhere 30's-90's most of the time. Linda was sure he wasn't interested in the crunchies the other cats ate, but on 2/18 she removed it from the whole house, and look what his blood sugar did. He had a shot that night (5.5u) and another one the next morning (5.0u) and that was it. Dry food can really increase blood sugar dramatically and it can sustain it there for a full day. Depends on how carb sensitive a cat is, but we encourage people to get rid of the dry food from a house completely, or feed it only to cats under supervision and pick it up to make certain the diabetic cat doesn't even get one bite.

I'd continue to hold his dose for 6 shots at the 1.5u, but i would remove the possibility of him being able to get into any dry food at all. not even one spilled crunchie on the floor. I don't blame you for being concerned about his high numbers - they are concerning - but would you try the dry food removal first? i suspect you're going to see a dramatic difference. I had a big boy like that - and he never passed up food if it was around! :lol:

 

I second this! I was giving Lantus dosing advice to a friend of mine who had a diabetic cat named Syd. While Syd only was given low carb wet food to eat, my friend continued to keep dry food upstairs in her house for her other cat. She thought Syd was safe because he hadn't been able to climb stairs or jump onto the counter where she kept the dish in nearly a year because of his neuropathy. Syd started to go into remission, and during his first off-insulin trial everything looked great until his numbers suddenly shot up into the 400s again. I asked her if there was any way he was getting into the dry food, and she insisted there was no way. Sure enough, she called me the next day because she had found Syd upstairs, on the counter munching away at the dry food. As his diabetes improved, so did his legs and his appetite!

I can't give Bandit a single dry cat treat or his numbers will shoot up. A lot of diabetic cats are very sensitive to dry food and treats because they contain wheat, rice, corn, and sometimes even corn syrup. None of the Greenies Brand treats are diabetic safe (with the exception of the Duck & Pea dog pill pockets, if you ever need to use pill pockets for your cat). Bandit gets these treats which he loves and are diabetic safe: http://www.orijen.ca/cat-food/freeze-dried-cat-treats/. You can also pick up any sort of freeze dried meat treat, and that would work, too. If the ingredients are 100% meat, it's a diabetic safe treat.

 

it's so nice to see you, julia! :YMHUG:

for treats, i simmered chicken breasts - just plain ones from the grocery store - then cut them in 1/2" cubes, froze most and kept a couple of tablespoons out in the fridge for pokey treats. punkin loved them. Of course, i had to give them to my non-diabetic cat at the same time that punkin got any!

The Dog pill pockets - the duck and pea ones, are really smelly! but they are good to have available. I trained my cats to eat little tiny empty balls of pill pockets so that when i have to give pills to anybody, i just wrap in a bit of pill pocket and throw it on the floor.

 

Wow. What stories about dry food! So I guess your cats all starve between the time you go to bed and get up? This is the time mine are very active and I didn't want them to be hungry during the night. For sure I will give no more Greenies to Black Bear! Unfortunately, he doesn't like the Freeze Dried Beef or Chicken I have for the other two (and thanks for the link, I haven't seen this brand before so will look into it - I pay a literal FORTUNE for the ones I buy). LuLu can't eat raw meat - she vomits it up, so what to feed her. She is also always eating grass. I have checked her for parasites but she is ok. She seems to only be able to eat 1 teaspoon of canned cat food at a time. I also have a 5 month old kitten. I feel terrible not giving any of them anything to eat for 9 or 10 hours. Now my predicament is worsening. I was just talking with my husband Paul today about buying only the highest protein (oxymoron right?) dry food available in Ecuador.So you are suggesting I cold turkey everyone from dry food? What about my growing little boy? Maybe I could put out the freeze dried treats when I get up to pee. This will cost a LOT of money in the end, but it might be worth it.

 

I leave canned food out for 12 hour stints. All 15 cats seem to be doing well on it.

 

My feeling on canned cat food has been that it is just as bad carb wise for cats as the dry food. That's why I make my own food. I buy the canned because LuLu doesn't seem to be able to digest the raw meat. Hmm. I will try some experiments. Maybe I will leave some canned food out when I go to bed, and when I get up to pee, if noone has touched it, I will stir it up a bit and put some freeze dried treats down too.

 

That's the idea!

We all just keep experimenting until we find what works best for our family...both human and furkid!

Hopefully you'll find something that works well for all of you!

 

Chris is right, just experiment to see what works. I fed punkin at preshot and again 3 hrs later, both day and night cycles, and beyond that all he got was boiled chicken treats. I always checked him around +4 or +5, so he got some extra chicken then, but then yes, he went until the next shot without eating. he didn't starve - and he was a big boy!

Many kitties do ok with grazing, but if you've got a cat who will eat food the moment it's put down, you can't count on them grazing. You'll have to watch and see what happens with Blackie's blood sugar, but many cats who eat much with carbs in the second half of the cycle (from +5 or 6 until the next shot) will see their blood sugar rise as a result. The insulin wanes in the second half of the cycle, so feeding then can (depending on the cat) make their blood sugar be higher at the next shot time. Some cats graze - mine didn't, so i didn't leave food out. If i set it down he ate it immediately.

when you've got a kitty that can only eat a spoonful at a time in the mix, that definitely makes things more tricky. She may need a different plan than the rest. Blackie may need a different plan than the rest too.

i had one other cat with punkin, and she ate on the same schedule, but she'd have starved if he could've gotten to her food. I fed them on a schedule, 7am/7pm, 10am/10pm, with him in one room behind a closed door and her in another room. With a lot of cats that's more difficult. What some people do is put the food down and whatever isn't eaten in 1/2 hr gets picked up til the next time to eat. If you consider in the wild, cats would be hunting for their food and would no doubt go several hours in between eating.

The best we can do is give you suggestions to try on what works well with diabetic cats - you'll have to figure out how to make it work with your household.

Keep asking questions!

 

by the way, as far as canned food goes, i don't know how well our manufacturer's food list will do for you. The most updated one for North America is http://www.catinfo.org. You might look there and see if anything on the list is available in Ecuador. The lowest carb canned foods are the ones that are called pate, or classics. They're the traditional kind of cat food that comes out of the can in a solid chunk, with maybe a little jellied looking broth around it.

The gravy foods have more carbs in them - it varies from can to can, but definitely anything with the word "gravy" in it, or if it's loose in the can with gravy, is a higher carb food. Most of the gourmet sounding canned cat foods are either medium or high carbs. You won't be able to tell by the labels on the cans. There is a list on the site here that has the carb contents of canned foods available around the world, but i don't think it's been updated for a while.

The gravy canned foods can be used to bring up blood sugar that has gotten low. You'll want some cans of these kinds, or something like karo syrup (corn syrup), honey, maple syrup, for times when Blackie's blood sugar gets low and you need to pull it up.

In general, diabetic cats need low carb canned or raw food for their primary food. Dry food is much higher in carbs, usually, than low carb canned food. Some dry foods are as high as 50%ish carbs. Most people here feed in the 5%ish carbs for their main canned food. Anything less than 10% is considered low carb.

 

Oh good on the news that the pate is the lowest. That's what I always buy. I am feeling overwhelmed and very sad about having to keep making pin cushions out of Blackies ears. I look at them with a flashlight and there are red blotches all over the place. Tonight I had to stick him 7 times as I either got no blood or too little blood. I started crying. Poor guy. I am NOT going to stick him again tonight. His BG was way up again anyway and he didn't eat ANYTHING since 4pm, when he only licked a little of his yummy homemade wet food. I have decided to take up all the dry food until further notice. Even for LuLu and Renny Benny B. I haven't had the strength to see LuLus beautiful face looking up at me pleading for her "fix". Maybe now that Blackie needs all this stuff for diabetes it can motivate me to prevent the same from happening to her. Maybe she vomits and eats grass BECAUSE of the dry food, not the meat! Send me hugs and candles. I am going to need it! Going to bed now. Our darling Meka Ragdoll girl was stolen down here last October and we have been grieving and crippled and searching and aching for 7 months, and now dealing with all this. See http://www.shipshapesystems.com/Meka.html for pictures. I have been so deep in grief, and even suicidal often, that I have been going to bed at 7am for months now. I finally have been able to stay up until 9ish, but tonight, I'm done. Having to hurt Black Bear to help him is leaving me raw and full of tears. We have no children, are in our 50's, our cats are our family and children and loves. So it is very very hard. We have burned a candle for Meka for over 8 months now 24 hours a day. Thank you for your support on Blackies diabetes, I would be truly lost down here without it. Goodnight kind souls!

 

((((heidi))))

what a struggle this has been for you! i'm sorry for your loss of Meka - it's never easy to lose the little ones we love. Meka is gorgeous - what a beautiful face. let's hope she is safe somewhere and someone is taking care of her. :YMHUG:

for Blackie, just know that what you're doing is going to keep him safe and help him heal. i told myself that so many times when we were starting out. When we started, punkin would hide under the furniture and i'd be pulling him out by his arms, hoping i didn't dislocate anything. I didn't, and we faithfully gave treats after every poke, and he did get used to it. it eventually becomes routine. at one point i was testing him while holding the phone on my shoulder, and i thought i'd finally made it if i could manage them at the same time. You'll get there too!

a hint - when you're done testing, always staunch the spot for a few seconds with firm pressure. we cut paper towels in little 1/2"x2" strips and kept a stack by the testing supplies. that will help prevent bruising. it helps to know that the poking you're doing, that seems to be doing nothing, is actually stimulating his body to grow capillaries in his ears. The first couple of weeks everyone struggles to get blood. After the capillaries grow, you'll get blood pretty much every time. It takes about 2 weeks for that to happen.

you have to take care of yourself so you can take care of your furkids! if you have cats that won't eat anything except dry, as hard as it is, you need to keep giving them the dry food. as long as he'll eat canned or raw, just keep the dry food from Blackie. cats can't tolerate a rapid weight loss, so even if one of them needs to lose weight, it's got to be very slow. keeping cats eating is important.

tomorrow is a new day. it gets easier - we did this for 2.5 years before punkin passed away, and i would go back to it in a heartbeat for the rest of my life if i could have him back. of course we never get that opportunity, but my point is that it will become routine for you and won't be nearly so stressful as it is right now. the starting of this feline diabetes is like a crash course in college, but fortunately, you have us to teach you and coach you on the little things that will make it easier.

Sleep well - seee you tomorrow!

 

It does get easier, Heidi, I promise! I was a wreck the first few weeks Bandit was diagnosed. He fought me tooth and claw with the testing, but he finally came around it became no big deal. Putting pressure on the spot for about 20 seconds after poke helps quite a bit to prevent bruising. I also put a tiny bit of polysporin ointment + pain relief on the poke spot after, and that helps a bit.

Of course not! Bandit eats 4 times a day (every 6 hours), which is the same feeding schedule he had on insulin. I would get a test at 7am when I got up, and then I would feed him and give him his insulin at the same time. He would get another test and a shot at 1pm, when his insulin was peaking, and we'd repeat this again at 7pm and 1am. If I am in bed at 1am (I usually go to bed around 10pm on weeknights), then I freeze his 1 am meal, and put it in an timed automatic feeder to be released at 1am. Bandit is a VERY food motivated cat, so believe me, he lets you know if he's hungry! Sometimes I'll give him a snack at 10pm of Fancy feast appetizers (which can also be used as treats) if he seems super active that day, but other than that he's just fine with his scheduled feedings. Cats eat small, frequent meals in the wild and don't have 24 hour access to food, so a little normal hunger isn't a bad thing, and can actually be very beneficial to the cat's behavior and health. It helps puts them on a more regular Play/Eat/Groom/Sleep schedule.

Also, leaving wet food out to free feed is an option, too. Unfortunately, I can't do that because Bandit is so food crazy. He is formerly obese (when I free fed him dry food) and will eat and eat both canned and dry food until he vomits, and then continue to eat some more. So we are very strict with the amount of food he gets per day and his regular, frequent feeding times. If he has to go longer than 6 or 7 hours without eating, he'll tear my house apart.

 

Thank you both Julie and Julia for your encouraging words on all fronts, Meka and Blackie. Blackie has growled the last couple of shots and on the 7Pm shot he tries to hide in the garden. I am lucky it is him and not LuLu, as SHE would be impossible to deal with. Blackie is pretty laid back as things go and is such a trooper. I will put pressure on the sticks now, and I am sooo encouraged to hear that the "splotches" will grow more capillaries so I don't have to keep going for the vein on the edges of his ears! I will look for a timed feeder but I highly doubt they will have such a thing down here. I agree, not free feeding all the time would be better for the cats. With no dry food all night, Blackies BG was still way high this morning, although 35 points lower! Still above 500. The insulin seems to bring it down to the 300's for just a few hours and then it goes right back up again. I still think 2 units would be better for him, but I will stick to the advice, and wait until after 6 shots of 1.5U.

 

It is possible you'll need to raise the dose in a few more shots, but Lantus needs to build up a reservoir under the skin before it will start working to lower blood sugar. That's why we wait at least 72 hours (6 shots or 3 days) to raise the dose. Sometimes you don't see the effects of a dose change for days after you raise the dose, so you don't want to raise the dose until you know for sure.

 

We know it's hard to be patient, and hold off on increasing that dose of Lantus/Glargine insulin, but it's the best thing for Blackie.

Here are some "patience pants" for you to wear, from my vast and expansive lending closet.

I didn't know your favorite color, so hope the rainbow colored ones are a good match for you. ;-)

 

hahahaha - Heidi, it's an ongoing joke around here that people need patience pants. we've all worn them, although i must say i've never had such beautiful ones as those, Deb! :lol: You're very kind to share your beautiful ones with Heidi!

 

haha_smiley Thank you for the pants! I LOVE them!

 

Black Bear knows I am trying to help him and he is cooperating. He was outside in the dark tonight and when I called him he came in for his check up, shot and dinner.

 

What the hell is going on? Blackie was stabilizing nicely at 300 and so I upped the dose .5 this morning, and this afternoon he was almost 600! He is on the downslide now but just barely. Gave him another 2.5 tonight. He still has a long way to go to get under 150 which is my goal. He absolutely DID NOT eat any high carb food today that could have spiked it. Maybe it just does that in the beginning sometimes? I see an earlier post that too high a dose can spike the BG too. But I did not hastily raise it. I had Blacks on 2 units for 1 night and then 4 days before raising it.

 

there are a few possibilities.

- is there any possibility at all that he could've gotten any dry food? seriously, any at all - even a couple of crunchies?

- he could be bouncing. i have seen many, many cats who in the beginning ONLY go low at night and spend their days bouncing from the low numbers at night. If you can get a before-bed test every evening, say a +3 - +5 that will let us know if that's happening. I know you go to bed early, but this is really important to figure out a way to get some test in the pm cycle. cats can have completely different pm cycles. really.

- it could be New Dose Wonkiness. For some reason some cats respond to a dose increase with higher numbers for the first day after the increase. you just wait it out. The second post in this link gives an explanation of bouncing.

- we could simply not be at the right dose yet. Some cats need more - it's very individual

I would've also increased, but i'd want to be sure he's not going low at night first. If we can be confident he's not going low at night, you could increase after 6 shots at a given dose. That speed of increasing can get them out of high numbers faster, but really - i know i'm beating a dead horse here, but it is that important - you have to be certain he's not going low at night. Low numbers at night can cause high numbers during the day. Many people post here daily to get advice.

I would encourage you to do these things:

- continue your testing as you've been doing and add one evening cycle test between +2/+3 and +7.

- make sure there's absolutely no other food available except the raw or low carb canned that he can get to.

- test daily for ketones while he is this high. You can find Ketostix at pharmacies (for people). Some people can catch the urine stream and either put a ladle to catch some or stick the ketostix in the stream. i had a temporary box (inside a plastic bag) with of dry lentils (you can use that, dry beans, gravel, anything non-absorbent etc.) and when punkin peed, i could tip the box and test the urine.

Hang in there Heidi - it's grim to see these high numbers, but we've seen them in other cats too. We will stick with you and he will get into better numbers. :YMHUG:

 

Thank you for the detailed post and for taking the time to do it and for the links. I will just get up and test him in the night for a few nights. I get up to pee anyway at least a couple of times, so will just do it then. If the times don't work, I'll set my alarm. Unfortunately, here in Ecuador, they look at you like you have 4 eyes and 2 heads when asking for a ketone pee strip. They don't have them here. I will get some brought down for me from the US.

 

I have a small baby sock that I partially fill with rice and tie off. I heat this sock about 15 seconds in the microwave and then hold it to me cats ear. This helps to dialate the capillaries so that they bleed easier. After getting the blood I hold pressure about 30 seconds and then rub vaseline onto the ear. This keeps it soft and prevents is from becoming sore. My cat tolerates it very well. Three things to think about with regard to dry food...1. it lacks moisture 2. it is higher in carbohydrates 3. most dry food have a high content of plant based protein. My cat was addicted to dry food when she was first diagnosed. It took a week to 10 days to transition her from dry to wet. It also took some time to adjust her feeding schedule and portion allotment. Regimenting her schedule was paramount to bringing her sugars into control. Within 8 weeks of going on the glargine her sugars stay within a consistent range. Her coat shines. Her dry , scaley skin is resolving. She is drinking and peeing within normal limits. And her old personality has reemerged. I believe that switching her to a wet food regiment made a remarkable impact in stablizing her sugars and bringing her back to a healthy state. Any change takes time to adjust to. And, make only one change at a time so that you know whether or not it is truly working. I lok forward to seeing better results for your cat in future updates. Jane and Stewey

 

Thank you for your support and input of experience. All heard and recorded in my brain! I'll have to find something that works for Black Bear and me. This is exhausting and very, very expensive. Down here, 50 test strips costs $47.00. That is going to add up fast. And regular canned food down here is only available at one store, and it is $2.40 for one small can. During the day I feed Blackie my own homemade wet food. At night, I am learning and experimenting. Time will tell. It appears that his BG is slowly coming down again after the increase to 2.5. I'll ride it out a few more days and see how it does.

 

You'll want to make sure what you make is nutritionally complete. For an example recipe, check Cat Info.

 

LOL! Here is my wet food recipe: 1 3 lb (more or less) raw fresh chicken breast ground, 1/4 teaspoon Taurine, 1/4 Teaspoon Vitamin E, 1 4000 IU D3, 3 ground Nutri-Cat Vitamins, Oil from 4 1000 mg Wild Alaskan Salmon Oil capsules, 2 or 3 raw eggs, 1/4 teaspoon sea salt, 1/4 teaspoon lysine powder(one of my cats has herpes), 4 drops iodine, 2 tablets complete B-Right, 1/8 teaspoon spirulina, 1/8 teaspoon wheat grass powder, 1/2 teaspoon each of slightly melted raw butter and coconut oil, 1/2 teaspoon extra light virgin olive oil, a pinch of raw bee pollen, 1 sachet FortiFlora. All mixed together really well with an electric beater. I don't freeze this. It lasts in the fridge up to 3 days easily. To serve a portion, I add water and warm it to room temperature on the stove. I got the basics of the recipe from Michelle Bernards book 'Raising Cats Naturally'. She says you can freeze it, but I found out in research that freezing meat reduces it's nutrition by 88%. Sometimes I throw in a raw chicken liver too. Depends. Chicken livers don't last long before stinking, so if it is just on market day and I make up a batch of food, I add one. If not, I leave it out. I also don't grind up bones anymore to put in the food. I do use a Tasin Grinder, but find that the bones make little hard pieces and the cats don't like it. With all the rest I put in, they should be fine.

 

yikes, heidi - that is expensive! i know American Diabetes Wholesale doesn't sell internationally, but I wonder about Walmart.com. You might investigate if you can get strips mailed there. Otherwise if you have someone who comes to visit from the US, perhaps you could have an order sent there and brought to you. ADW is an affiliate with http://www.mrrebates.com and their diabetic supplies are pretty cheap. If you register first with mrrebates you can can get a percentage back after you've spent a certain amount. It sounds like a US visitor might be apossibility for you, if so, that's going to be a much cheaper way to get supplies. I bought everything through them - these http://www.americandiabeteswholesale.com/product/terumo-thinpro-insulin-syringe_5891.htm syringes have 1/2 unit markings and a thin barrel, which makes changing doses by 1/4 unit much easier, the generic Arkray strips that match the Relion meter, and the lancets, which are fairly cheap everywhere here. The generic strips I used were 250 strips for about $70. Punkin died a year ago, so i don't know the current prices, but it's far less than what you're paying. Our brand name strips in the stores are about what you're paying for strips now.

I understand about making it work for your family - i just want to make sure you understand (because new people never do) that low numbers can cause high numbers. Or high numbers can be from not enough insulin to counter whatever carbs they eat. There are also some conditions that cause the need for more insulin than the average cat. The only way to know which situation applies to your particular cat is through looking at enough data.

Sounds like you're doing the best you can - i think you're off to a good start. Feline Diabetes is a tough disease, but it becomes manageable and easier as you get more experience and understand more.

 

Well, his numbers are still really high. I had him on 2.5 for 6 days. Upped it to 3 today. I'll keep close watch. Thanks for the info on the supplies. I figure even if I can get his bg to stay in the 100's I have a huge accomplishment.

 

Have you read over the Tight Regulation protocol for Lantus?

For the first dose, you hold for 5-7 days. At each dose increase, you want to hold that for 3 full days, then evaluate the nadir for adjustment. With high nadirs after 3 full days, you can increase 0.5 units at a time; with lower nadirs, you increase 0.25 units at a time.

 

Thanks for the info.

 

YAAAAAAAYYYYYYYY!!!! We've gotten into the 100's today!!

Today, for the first time since beginning June 12th, Blackie has reached the 100's!!!!!!!!!! Blue, blue, what a wonderful color!! I have had mostly only black and red on his chart so far. It sure has taken "going low and going slow" patience beyond my comfort zone! He is now up to 6 units 2x a day. He obviously has had very, very bad diabetes and for a long, long time. Poor guy. I am finally breathing a sigh of hope that we may be able to stabilize Blackie in the low 100's, still going up into the 400's on the night shot test. We are finally going in the right direction. Thank you all for your assistance in the beginning when I had no clue how to begin!! After we get stabilized, IF we ever get there, I will be looking at all the information available concerning the next phase, maintenance and then the possible next phase, remission and what to look for in that case.

 

Just looking at his spreadsheet and notice that you don't have any pm tests in - are you able to get any pm tests?

I also noticed that you take the am tests at the same time each day - how about varying the times, a bit to see what other times his bg is at - instead of taking at +6 take a +5 or +4 or +7 or +8....it helps to see more patterns.

I haven't read through all the posts on here so I don't know all the history.

I do see that when you raise the dose, you raise a conservative amount 1/2 unit that's good. Cool you are making your own food for him, bet he loves that.

 

now that you're seeing blue numbers, heidi, you want to slow down the dose increases. 1.0u increases are large enough that you might miss a good dose. Go back to 0.5u increases, even at 6.0u a 0.5u increase is large enough.

typically we suggest people get their cats tested for acromegaly and insulin autoantibodies (iaa) when they get to a 6u dose. there's something going on that is causing a need for that much insulin.

i hope things have improved in your own life in the past month. earlier you'd said you weren't able to get pm cycle tests, but Hillary is so right - night cycles can look completely different than the day cycle and cats typically go lower at night. you could easily have some low numbers in there. if there is any way you can get a test in the pm cycle, it's going to give you more confidence that your dosing is appropriate. Without some tests in the night cycle, it's hard to know if 6u is appropriate or not. Most cats get 1-3u per dose. He could also have a high dose condition.

 

Thanks for the suggestions. I will have my husband test him around +3 in the evening. We don't plan to raise the insulin any more for a few more days and if we do, it will be .5 as advised. Blackie is still all over the map though, with his BG. Yesterday he was low in the evening... and all night he only had accessible some dry Diabetic Royal Canin food, but this morning he was 456. WTF???? I am feeling that perhaps it is too late for him and that his system is not going to come around. As for testing for the acromegaly and insulin autoantibodies (iaa) I will see what I can do here. I might be able to get it tested here but I doubt it. I now only feed Blackie his Royal Canin Diabetic wet and dry, and my own homenade raw chicken food. But since this mornings reading was so off the charts, I am feeling despair.

 

How about removing the dry food from his diet and see if that lowers the bg's....my guess is that it probably will...

 

But then he will not have anything to eat all night long unless I set the alarm and ruin my sleep every night and get up at 1AM to feed him. I can't leave the wet food out as the other two cats eat it up before he does, and it costs a FORTUNE, the Royal Canin Diabetic Wet. If he has the tumors, I think I will just let them take their course. I simply don't have the money nor the resources here in Ecuador to address this type of surgery.

 

But if I remove the Diabetic dry food at night, he will have nothing to eat at all for several hours. I can't leave the wet food out as the other two cats will eat it before he does. The only other option is for me to ruin my sleep every night and get up at 1-2AM to feed him. If he has tumors, I will have to let the disease run it's course... as I have neither the resources nor the funds to opt for surgery here in Ecuador. He is already 17 years old. He probably would not survive the surgery even if I was able to do it.

 

Overnight are you able to separate him from the other cats? If you can, then you can put him in the bedroom with you, with food left out (you can do the freeze and thaw method) and this way you can be sure that only he gets it.

 

I have posted this text twice now but it keeps disappearing off the thread. Not sure what is going on.. so forgive if they all suddenly show up. I will consolidate as needed. If I don't feed him the Diabetic Royal Canin dry at night, then he will have nothing at all. The other two cats (plus the neighbors cat that visits at night), will eat any wet food I put down before he does, and the diabetic wet food is very expensive. I will have to get up at 1 or 2 AM and feed him then. If he has tumors, and getting it diagnosed here in Ecuador will be difficult if not impossible, and surgery is an option, I will opt NOT. He is 17 years old, and I doubt he would survive it. So I will be educating myself on the signs of organ failure for him, so if that happens I will say goodbye to him. It says that if the cat does not get stabilized after 4 months of insulin, it is probably the tumors.

 

It's showing up, maybe you are just having an internet delay.

It seems that there is some missing information... Is your cat outside the house or inside the house only? When you say the neighbor's cat shows up, I assume this cat is showing up outside the house and going to the feeding station you set up. which is why I am now asking where you keep your cat in or out of the house?

Which I then will repost this:

Overnight are you able to separate him from the other cats? If you can, then you can put him in the bedroom with you, with food left out (you can do the freeze and thaw method) and this way you can be sure that only he gets it.

That is the only way I can see to solve the problem of other cats eating his food.

 

heidi, i didn't remember that you were giving dry food. the dry food would change my suggestion about testing for a high dose condition. at least at this time. even a few kibbles of dry food can raise blood sugar and keep it there, so if Blackie is getting dry food daily, even literally 5 pieces of crunchies, that would create the condition where you'd be needing more insulin. We've had members do experiments with the dry food and it's amazing how it can affect a carb-sensitive cat.

it also explains high numbers, and erratic numbers. another likely scenario is that Blackie is sometimes getting lower numbers but bouncing from them. Bouncing is the cat's body's way of preventing a perceived hypoglycemic episode, even when the BGs aren't low enough to truly be a danger. Here's a post about that and about New Dose Wonkiness, which is the unexplainable phenomenon of increased blood sugar following a dose increase.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=46012

Here is Linda/Scooter's spreadsheet. Linda has 13 cats and was pretty sure that Scooter wasn't eating any of the dry food around because he didn't seem to be interested in it at all. But it turned out that when the dry food was completely removed from the house, Scooter went from 5.5u per dose to off of insulin in 2 very long days. Look at February 18 - the comment on the far right says that this is the day the whole house went off of kibble. Feb 19th was the last day that Scooter got insulin and he's been diet-controlled ever since. Dry food is powerful stuff. Going off of insulin doesn't happen to every cat, but we've seen it more than a few times when the dry food disappears. https://docs.google.com/spreadsheet/pub?key=0AqyJS-ud54lgdHU2S2FwczByM3YwU2JjRFduOWJLUHc&output=html

Don't despair. We do this all the time, and I think with a little more information & coaching we could help you change what is going on with Blackie. Your husband's +3 test will really help us be able to see what's going on.

i'll just add that i almost never look at the Main Health board unless someone posts over in the Tight Reg group and asks for help, or sends me a pm asking me to look at someone. I see your post because it comes up in my list because i've posted in your thread before. Hillary is great about checking Main Health and helping people. If you're really serious about getting Blackie regulated, it can be done. You'll need to get those night cycle tests sometimes, get rid of the dry food entirely (but be prepared to reduce the dose when you do), and be open to learning a little more about how this all works.

I'm glad you've hung in there this long. It gets easier as you learn more and understand why you're seeing high numbers and how to get rid of them. knowledge is power. Truly. And even if Blackie doesn't go off of insulin, you can learn what needs to be done to keep his blood sugar low enough (tightly regulated) to prevent organ damage from high blood sugar. It's possible. Hang in there! :YMHUG:

 

What do I do if Blackies BG before the night shot tests between 80 and 120? We have encountered this 4 times in the last week. I went ahead and gave him a lower iu insulin shot, but what ended up happening is we had to give him emergency "high carb" food and honey at +3 because he was going way to low (which pushes his bg reading at 6am into the 2 or 300's. Last night he hit 51 and scared the holy crap out of me. So tonight, actually in 1 hour, if he is in the normal range, I am thinking I won't give him any night shot. Instead, I'll check him again before bed... if he is above 120 at that time, I will give him a SMALL dose - like maybe 3 units? This is the hard time when he is finally responding really well to the insulin, to keep him in a satisfactory dose, but not go too low. I am happy if he is even stabilized in the low 100's eventually. He is always a bit high in the morning... but with the morning shot it comes right down by noon. We have had some roller coaster reactions the last few days so don't judge it by his recent numbers... I think we can start lowering the insulin dosage now.. this morning I only gave him 5.5. I suspect it will he will be in the low 100's at 6, but if he is between 80 and 120 - I dare not give him any as last night, he went to 50.

 

I would reduce the dose to maybe 5 or 6 units. You are getting too much of a drop on the AM shot which results in a very low PM PS.

 

[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

Glucose Reference​

* * * * * * * * * * * * * * *​

Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)

 

hi heidi!

i'd really, strongly encourage you to not leave him unattended when you catch a number in the 50's at +3. It's very likely he spent a significant amount of time under 50 on the night of August 2nd and could very well have become hypoglycemic. I can't tell when Blackie's typical nadir (low point) in the cycle is, but it's very common for cats to continue to drop until about 6 hrs after their shots.

You want to continue to test until he has had at least an hour of rising numbers after you've stopped giving him carbs.

When he goes below 50, test every 20 or so minutes, and if he's below 50 give him a teaspoon of gravy from high carb food or a couple of drops of corn syrup or honey.

or you can post here and someone would help you through it. Yes it will mess up your sleep and take a lot of strips, but it will keep him safe. Hypos are nothing to mess around with and we see cats die from them - i don't want that to happen to you.

Lantus builds up in the body in a depot and sort of slow-releases. That depot size is related to the size of the dose. So his 6 unit shot this morning is still affecting him tonight, even though you gave 4u tonight. It can take as many as 6 cycles (3 days) for the larger dose's depot to reduce and equalize to a lower dose. My point is that he could still go in low numbers even after you give a reduced dose and i want to make sure you're aware of that.

 

The raw recipe looks good except that you don't balance the meat with bone - I also have Michelle Bernard's book and the recipe we use most for a raw diet was derived initially from her book as well, although I don't remember the raw butter and olive oil.

One of the most crucial matters about raw feeding is making sure that your cat has a proper bone to meat ratio. You have a good grinder but maybe you could use a plate with smaller holes. My cats don't even see the bone in the ground meat. I grind the chunks separately through a plate with bigger holes. I believe it is unhealthy to feed raw meat without bone or bone meal due to the imbalance. Dr. Pierson at catinfo.org discusses this here: Catinfo.org

My kitties are less hungry on raw food. I took all dry food up and threw it out for all my kitties in one day. They went cold-turkey off dry and survived. This meant, though that I had to give a before-bed meal which was at about 11:15pm. Their overnight hunger calmed down soon after and even with them being active at night, they don't seem to be bothered.

My heart breaks for you over your missing ragdoll. What a beautiful cat. Blackie is in good hands - you are here and we are here to help. We can hold hands, let you vent, let you cry and share in your successes!!!

 

Hi Heidi,

I hope you are still reading your post and I hope Blackie is doing well or even better than well.

I do have a small concern and I don't think it was picked up by anyone yet. If someone has I apologize. I'm still a newbie myself.

How are you 'warming up' your insulin? I noticed that you said you warm it up prior to shooting. In my limited knowledge warming it could impact the quality of Lantus if you are doing it in the vial. If it is after you draw into the syringe and you're handwarming, no harm done - I believe, someone correct me if I am wrong. I was just curious and I only saw your post today so I thought I might ask.

I keep my Lantus in the refrigerator at all times, draw it cold, and shoot cold. Simmie, who use to be a big bully at 22 lbs. doesn't care at all about the temperature, or even the shot, at all.

Just a thought.

:YMHUG: :YMHUG:

 

Oh sorry! I didn't realize there was a second page to your posting. It looks like my concern might not have any bearing on your situation.

Hugs,
L

 

Well, am I the only one that almost killed their cat with a mistaken reading? This morning I read "502" - being very sleepy - but the meter was upside down... it was 205. I proceeded to overdose Blackie and didn't realize it. I had to go out at noon so I checked him early at 11:20 and his bg was 51. I quickly gave him some "high carb" canned cat food. His bg is now only 94 several hours later. I am NOT giving him a shot tonight if he is in the normal range. He is beginning to respond very quickly to the insulin, so we are slowly reducing the dose amount. Maybe this means good news in the long run. It is so hard to regulate him and when you do things like I did this morning, it seems like we will never get it right. Poor guy. We don't want to "chase" the numbers so if it is high, we just stick with the dose. We were doing good starting to lower it and then I did what I did this morning. If I had read it properly, I would have given him only 4 units this morning.

So what do we do when there is a normal reading (BG between 80 and 120)? I am going to wait and check him again at 10 or so, and if he is a little above normal... like 150 or so, I will give him only 2 units for the night, no more than 3 at this point. I am feeding him only the diabetic dry food at night. I think this will be fine for him as on a normal run of days, he is showing up ever lower in the morning. Low 200's now ... so he is going to be ok I think at night. If I could just get him down to the 100's in the morning reading, that would be good enough for me at this point.

I can't isolate him and I can't not feed him anything at all all night long.. a higher reading in the morning is better than him not eating all night. He is very active at night and so needs something. But like I said before, I think that as he levels out the Royal Canin diabetic dry food will be ok for him.

It is good to see that he is responding faster and faster now... is this normally what happens if we are lucky? Maybe this means eventually, in spite of his age and the fact that I suspect he has been sick for a long time, he may go into remission. Worst case scenario, hopefully I will be able to keep him in the normal or 100's range.

His ears are sometimes so dehydrated that I can't get any blood .... especially at the 6AM check. It's horrible to stick him so many times ....

 

Yes, I did that with ProZinc.

Maybe put a strip of brightly colored tape on the 'top' of the meter to visually cue you which way you need to read it.

 

Are you heating his ear before you stick it? It can really make a big difference. You can take a sock and put a little rice in it, tie it off and microwave for about 15-20 seconds, hold it to his ear for a little while before sticking. Another trick is to take a small pill bottle or film canister and fill it with warm water and use that to warm the ear. Test on your wrist like you would a baby bottle to make sure it's not too hot. The pill bottle also gives you something hard to poke against.

 

Hi Heidi!

It sounds like you are doing all the right things and this 'mishap' that you experienced in reading the glucometer is probably just one in a few mishaps you'll/we'll experience along the way. In my early days of testing I got so caught up in the test/feed/shoot (TFS for me) that I forgot the last step! I was so excited/obsessed to get the testing in I actually would on rare occasion, forget to shoot! HORRIBLE. Now I keep a chart up on a cabinet where I keep Simmie's 'pharmacy' inventory so I never forget his insulin again. Especially since his vial is out of sight.

Which brings me back to the question about the storage and management of your insulin vials. Would you let me know how you store the vial and how you handle it before and after you shoot? Just to be on the cautious side.

Some of us are very strong in all aspects of managing our furbabies' diabetes and some have a learning curve that requires us to provide some cues or reminders every day for ourselves to manage all the steps and scenarios we might run into. For me, it was the elation of getting a test done then remembering to shoot (I know that sounds really dumb) but for others there are so many issues along the way which needs some kind of 'poke' to remember!

You are truly fantastic. Love from me and Simmie to you and Blackie!

 

Suddenly in the past few days, Blackie is responding drastically to the insulin. Is this common? It is good (if I don't kill him first), as I try to find the "sweet spot" in the dosing. Maybe it is a sign that he will take himself into remission, even though he is old and has probably been sick for a long time?

When it is time to shoot at 6PM, If his BG reads normal or just above normal range, I have been NOT giving him any the last couple nights until later, and giving much less later. It seems we are now in the "dangerous" time where we could easily overdose him. I am erring on the high side as of yesterday, as if you look at my chart you will see I have almost killed him several times these past few days. Am I the only one struggling with this new stage? All the places I read say DO NOT GIVE INSULIN if the cat is in the normal range. And I have given before I read that, and almost killed him. This has become a chasing cycle now and makes it really tough to keep him regulated at any number.

I only gave him 2.5 units this morning even though he was high, as he literally PLUMMETS now after the morning shot... gotta be SUPER careful. He eats the Royal Canin Diabetic Dry food around 4:30- 5AM so when I take the BG at 6, he is higher because of that. Gotta take that into account for the dosage. I have been WAY WAY WAY overdosing him lately. Since he is now responding in big number drops quickly, better to err on the low unit and watch how he is around noon for a few days. I don't want to see him going from 51 to high 300's every 24 hours. I'd rather keep it in the 100's to 300's. I am not going to remove the dry food at night... he seems to be turning up lower and lower bgs in the am as he adjusts so I think once I get him regulated (or some semblance thereof) it won't spike him so much.

I can't afford to check him more often, as test strips down here cost a fortune. I am doing the best I can.

Again, the questions: Is it common for the cat to suddenly begin responding drastically to the insulin? What do I do if his BG is in NORMAL range, 80 - 120 or very close to that? As I said b4, I can't give him any insulin if he is normal or close to normal now, as his body sends him plummeting into death numbers.

 

All of a sudden all your replies came in and my old post was suddenly there. Good grief. Thanks for your answers and I am glad I'm not the only one to mess up so badly. I don't have a microwave but I will try to massage his ears more... I am afraid to as I am sure they are sore!

I keep the insulin in the fridge. I test Blackie now 15 mins prior to the time to shoot so I can decide on how much to draw. I take the insulin out of the fridge, draw, put it back in the fridge. The insulin in the syringe warms up to room temp by 15 mins, and I give him the dose.

I won't EVER EVER make the same mistake of reading the meter upside down again!

 

What do others do when the PMPS in the evening is normal?

Here are some answers for some of you:

Hillary & Julie - our cats are indoor/outdoor cats. They have access to the outside 24/7. We have a tall chain link w/barbed wire fence entirely around the property to discourage intruders. The neighbors cat still finds a way in... and I suppose when our 7 month old gets a bit older and before we neuter him, he might try to get out to have a look around the area... but I firmly believe that cats, if at ALL possible, should have access to the outside. We don't even have a door to any room in the house except those to the outside, so isolating Black Bear at night is impossible.

I admire you Robin, for your dedication to your furry ones. We get up at 5:30 to prepare for his morning shot. If we stayed up until 11pm to feed everyone (so we could pull the dry food away) we would get seriously sleep deprived and then everyone suffers. Not an option for us. Black Bear only gets access to the DIABETIC ROYAL CANIN dry food at night... I at least went as far as getting him expensive prescription diabetic dry food for the night times. I put a mixture of Royal Canin Fit 32 and a small amount of other kinds of dry food for the others, on a high table at night - which he absolutely CANNOT access. He has bad hips and can hardly jump up to our bed, much less a high table - so we're safe on that count. All the cats love the Diabetic dry food and seem to prefer it over the stuff on the table. I like to give them some variety, instead of the same old meat food day after day. In the wild, of course they wouldn't have that choice as much, but since they are domestic, I try to find a medium balance. Which leads me in to a bit more on the bone and bone marrow... Aagonus Vonderplanitz, in his controversial book "We want to live, the Primal Diet", addresses that all the toxins in the body of an animal goes in to the bone and bone marrow.... so feeding them bone and bone marrow is not so great as once thought. Our 4 year old Ragdoll, LuLu, can only eat 3 to 5 licks of wet food (especially meat) in a sitting. If she eats more than that, she literally throws up her guts every time. The only food she can keep down is dry. So what do I do about that? I can't cold turkey her... I have tried. She went 4 days with about 15 licks of wet food each day and was crying pitifully with hunger ... I couldn't stand it. We have a complicated household and have had to make the tough decision to feed both dry and wet.

We will just have to live with higher numbers in the mornings for Black Bear for now as I try to figure out what is the best approach for us and him during the night. Yes, it is much harder to try to regulate him, and I know that the yo yo is not good for him, but neither would leaving him completely untreated and in 5 and 6 hundreds every day. So at least we are treating him, at least we are keeping him MOSTLY in the 200's on average. Sometimes even 100's. In the best of worlds, I would get up at 2am and feed him wet food so that his morning reading would be lower. But I am not willing to go that far for him for years. If it was for just a couple months, I would consider it.

Again, I ask, what do you all do when the PMPS numbers are in the normal range???

 

I totally understand... I get up at 5:30 am as well to test, shoot, and feed all my monsters. Then I rush around during the last half hour to get showered, dressed and out the door at 7am for an hour commute. It is difficult to stay up late - I often have to wake myself up from the recliner for that 11pm feeding and then go to bed. So I totally understand but I would not make it through the night if they didn't have something in their bellies and it sure isn't going to ever be dry food.

So my idea of feeding through the low part of the cycle wouldn't work for you. I hope you can find a solution.

 

Have you considered using (in the US, anyway) Young Again 0 Carb dry food?

How about a timed feeder? The Pet Safe 5 seems to work well for folks here and is available through our shopping partner Amazon (use the shopping button at top of screen. Purchases made that way will belp support the message board)

 

Help! Today from the morning shot to +6, instead of going down at ALL it went UP. What in tarnation is going on? This is the first shot from a new lantus pen. Could the insulin be bad? Any other reason? As you can see from his chart, this has never happened before! (Inserting update - I gave him 1.5 units at noon and by 3 it had gone down quite a bit).

Thanks for the steer to Young Again Zero Carb. I will order some and luckily my husband is going stateside mid-sept so he can bring it back. I wish I had known about it b4 as I spent a fortune on Royal Canine Diabetic food and shlepped it all down here a couple months ago. It doesn't seem to keep his BG low anyway in the am. But maybe it would be in the 4 and 500's if he was eating the regular dry at night.

 

Hi Heidi!

The high this morning is due to "bouncing"....he dropped from 236 to 87 in 3 hours last night and that's a big drop. I would have strongly suggested setting an alarm and getting more tests in last night because he could have continued to drop and even gone too low. When they drop fast like that, it's best to check a little later and make sure they're not continuing to drop.

Lantus needs to be giving at a consistent dose. We don't base the dose on the Pre-shot numbers. They are based on the nadir...How low it's taking them. Since you have kept changing his dose lately, he's not having a chance to "settle into" a dose and really show you what he can do on that dose.

While I understand you're choosing to continue to feed the dry, you're right that it's going to make regulating him harder and he will need more insulin than a cat on a low carb diet, but going up by whole units can easily bypass the "best dose" for Black Bear. We never increase in whole unit increments so we don't pass that "best dose" without knowing it. He seemed to be getting some good numbers at 6 units and 7 units but since you weren't testing on the PM cycle until just lately, there's no way to know if those would be good starting points at this point or not. My first thought (since he's starting to show some signs of green and blue numbers) is to try shooting 5 units every 12 hours and get those PM tests in and lets see where he's at in a few days time.

If you're getting a PMPS that's too low to shoot, it means you're giving too much insulin. We need to find a dose that you can give every 12 hours. When they are lower than normal, but still above 50, that's a good opportunity to learn to "shoot low to stay low" (shoot a lower number to keep them in lower numbers) Most of us will shoot anything above a 50 once we have the data to know how our cats respond. Shooting lower numbers does require keeping an eye on them though...for however long it takes to make sure they're safe overnight.

I know it seems like there's a lot of "Rules", but the protocol we use is proven to work. Now that he is getting some better numbers, I'd really suggest shooting the same dose AM and PM unless the Pre-shot is below 50 and testing as much as necessary to keep him safe...that may mean the dreaded alarm clock though sometimes.

 

Thank you for your input Chris. It seems to me trying to keep the numbers between 50 and 100 is playing Russian Roulette as it could easily go too low. Unfortunately for me, it costs $40 for just one container of 50 test strips. I am spending $100 a month just on test strips and we are on a fixed retirement income and were barely making it financially before. I wish companies weren't so greedy but that is just the way it is. I have ordered 6 months worth of test strips from India for a fraction of the cost here, but I won't get my hands on them until the last week of September. So testing more frequently to find the "nadir" is really costing us right now and he is so all over the map that it seems an impossible task to do this.

Everyone keeps saying that I am not putting him on a low carb diet, but diabetic dry food IS low carb. And during the day all he gets is my homemade raw chicken and vitamins food. I am going to order a couple 25 pound bags of Young Again also, but won't get that either until last week of September. I can then see if that will bring Blackie to a lower number in the morning.

We are slowly bringing him back in to the 2 or 3 unit doses right now. We had a couple of days where Blackie ran out into the orchard and we couldn't find him for the night shot. And a few other challenges too. So all of this will take time. At least he is mostly in the 1 and 200's now so we have made some progress. This morning he was playing like a kitten which I have rarely seen in him. So he must be feeling better at some level. His BG will get wonky on us just out of the blue sometimes too, with no rhyme or reason.

We couldn't have even done this without all of you so I thank you from the bottom of my heart.

 

It depends on which brand of diabetic cat food you have. The dry food may be higher in carbohydrate than you think. Check the food table at Cat Info. See if it is < 10% calories from carbohydrate, which is what is recommended.

 

Hi. Blackie's bg is shooting up to high 200s even low 300's lately. We have increased his Lantus doses up again to 3 2x a day. He doesn't seem to be responding. The only other kind of insulin we can get is Humulin which I read on here is not good for cats. I read that he could have a dental problem and that that can cause a prolonged spike... not sure what to do. Should I try Humulin for a week or two? Hate to buy it as we already have an extra unopened Glargine in the fridge. Blackie was down to 1 unit 1x a day for quite awhile. Then out of nowhere, started spiking. He is ABSOLOUTELY NOT getting in to any high carb dry food at night.

 

Hi Heidi!

I think it will help you tremendously to understand about how Lantus works. You've got a different dose at pretty much every shot. Lantus dosing is based upon how low the dose takes him. I get all your problems with strips and the other cats, but the low point of a Lantus curve is somewhere in the middle of the cycle most of the time, and at this point, you have no idea how low he's getting. That's essential information for making dosing decisions!

Here is a great post on The Insulin Depot that will help you.

Lantus is also a depot insulin, meaning that it builds up in the body and slow releases. When you change the dose, there is some immediate change, but there is also a delay to the change. People here give the example of the contrast between a speed boat and a barge. When you're steering a speed boat, you move the steering wheel this way and that and the direction changes nearly immediately. That is like a non-depot insulin.

Depot insulins are like steering barges. You make a little change (0.25u - NOT 1u or even 0.5u for most situations) and then you wait to see what the dose change does. With a different dose every morning and evening, you're not going to see consistency in his blood sugar.

I'd encourage you to post over in the Relaxed Lantus Insulin Support Group. They use Lantus and can help you learn a little more about how to help your sweet Black Bear. They also can suggest some things to help you since you can't test very often. I don't think your problem is the Lantus, I think it's in how you're using it. Understanding how to use it will help you get better results for BB.

 

Blackie started going up for no good reason 3 weeks ago. This morning was the highest reading yet since the beginning of June... 504! We don't know what to do. I tried a round of broad spectrum antibiotics... that didn't help. He is high in the morning, so we pound it down with higher doses and then at 6pm he is almost normal.. so the night dose is super low. I wonder if his body is just starting to shut down? Or he just got all wonky for no reason? I am now using the Young Again no Carb dry food at night..so it isn't that he is eating too much at night... in fact he is eating less then ever at night now as the Young Again is very filling. I hate to see his numbers so high. What are the signs that he might be dying now - ie. organs shutting down? He doesn't seem to be in pain.

 

Okay you're still using Glargine (Lantus) right? If so here is the problem Lantus is a depot insulin you need to give the same dose both morning and night. You can't pound down the high numbers with more insulin in one shot because it causes exactly the problem you are seeing wide swings. Because the shot you give in the morning isn't what they are using during that cycle to bring down the numbers. If he responds immediately to a dose change and it is dropping him too low to shoot at night then it's too high.

Mel and The Fur Gang

 

I'm still catching up on your thread but one thing that stuck out and I haven't seen anyone address it yet. But Lantus is an U100 insulin so on a U100 syringe you don't convert. 1u is 1u The conversion is only done when using a U40 insulin with a U100 syringe to microdose easier. That 1u on the U100 syringe is the same regardless if it is going into a human, a cat or a ferret. So if I haven't just missed it and some has addressed it and you've corrected your thinking and what you are calling your doses this might change the dosage listed on his spreadsheet.

Mel and The Fur Gang

 

Heidi, I'm just wondering if you're reading the responses you're getting. It's really helpful if you can read what people have written and respond to their comments and questions. That can help us help you move forward and help your kitty.

I'm quoting and repeating my last post below. From the spreadsheet, it looks like you might have missed this information, and I think that you're not understanding how Lantus works. As Mel said, you can't use Lantus to beat down high numbers. It simply doesn't work that way. You have to make SMALL increases, 0.25u at a time and give the dose change a chance to settle.

You also need to give the same dose shot am and pm.

In order to keep him safe, you really have to get some mid-cycle tests in. It is dangerous if you see a green number and you don't follow up with more testing to make sure he isn't going into low numbers. Insulin can kill - you can't be casual with it.

 

Thank you one and all for great support and information. Ok, so I have been really messing it up. We are trying to give him less in the morning so that he will be high enough in the evening to give him some. We are also trying to give the same dose each time... until we can inch it lower and lower the same. Hopefully we can get him back on the right track in a couple of weeks.

 

Don't beat yourself up too much Heidi! It really takes a good understanding of how Lantus works to figure it out.

I PROMISE you if you'll post every day and let us help you, we can help you get Blackie under better control!!

Since you gave 3 units tonight, let's just STAY at 3 units for at least 3 days, OK?...Unless he were to drop below 50

It's also very important for you to get at least one mid-cycle test in each cycle....maybe somewhere between +5 and +8 during the morning cycle and one test "before bed" at night

If you absolutely can't get a mid-cycle test sometime during the day, then you'll want to hold the dose even longer than 3 days, but it's even more important for you to get at least one test in on that PM cycle...and maybe on weekends do more testing during that AM cycle. We really need to see where the dose is taking him

Filling in those gaps as well as holding the same dose will really help us to help you....and Blackie may very well start showing some better and more consistent numbers instead of bouncing from too high to low and back up again.

Again...please don't change his dose without asking for help. Just stay at 3 units unless he drops below 50 and keep posting

 

But he went up to 557 this morning. That's death zone. We gave him 3.5 today... I know you say not to raise it, but it just keeps climbing. He was down to 1 or 1.25 from mid Sept until Nov 25 - when on the eve of the 25th of November he started to skyrocket for no reason whatsoever. Now he just keeps rising and rising. Since all you good people steered me back in the right direction, we started to give him less in the morning, so that at night we could also give him some. We tried to stick close to the same dose morning and evening the past couple of days... but when he shot up to 557 this morning, I couldn't just give him 3 - we upped it .5. Something else is wrong with him, as he was doing so well for sooo long, and now his numbers have gone sky high for no apparent reason. How can I just stand by and dose him low and watch him die because I didn't give him enough to keep him from dying on the high side? WHY is his sugar going so high all of a sudden without any reason? I have already run him a course of broad-spectrum antibiotic shots and that didn't help. He seems to hurt today when I pet him... he usually LOVES to be touched.. not today... he gently pushed my hand away from him. We'll check him mid-day and see what his sugar is... it seems such a waste of suffering for him and his poor ears to check him any more than that as after the mid-point between shots, he will start climbing anyway. There are absolutely NO VETS anywhere close to me that would even have the slightest clue how to proceed to help him at this point. So I guess if he goes higher and higher it just means he is dying and there is nothing I can do but sit there? Just keep the dose the same? Please understand, he was doing great for several months... he was not perfect, but we were happy to keep him under 200 most of the time. Even closer to 100 actually. So now he suddenly goes sky high for not reason... I just DO NOT get it. So if his BG is even higher tonight, I should keep it at 3.5? I am afraid he will die. He has gone down to 50 before a few times and seemed OK. But I don't know about the high numbers.

To answer you question am I reading your posts? When I go to the main page and check to see if there are any new messages it always says (O new messages) like below- so I figured nobody was responding to me when I posted early this month. When I finally went in to make another post, it was THEN that I saw all your posts. So now I just ignore the (0 new messages) and go all the way in to see if there are any posts.
User Control Panel (0 new messages) • View your posts

 

Without any BG reading between shots we do not know what is happening. Can you take some?
Cats tolerate high BGs with out problems for extended periods of time. My Badger throws BG PS' in the 400's regularly and infrequently in the 500's

 

It eases my panic a bit to know that other cats get up into the 500's too... but don't understand why. I'll take his reading at noon now... which is halfway between the dosing. We all know our darling friends will die one day, it is inevitable, (so will we) but I would like to prolong his life, comfortably, for as long as I can. His BG at noon now is 378. Hardly down enough for mid point - as it will probably go right back up to over 500 by 6pm.

 

Heidi, there are 2 things that are really really really important for you to understand.

1. High numbers do NOT always mean that a cat needs more insulin.

2. Lantus is NOT an insulin that can "beat down" high numbers. It simply doesn't work that way.

Sometimes high numbers are CAUSED BY low numbers. Sometimes high numbers are caused by increasing the dose. Please read through this post http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=46012 for information about this.

I can't say that you need to stay at 3.0 units. It's impossible to know what to suggest because of the erratic dosing. Think of this situation as rocking the boat. Everytime you change the dose you increase the rocking. That's at least one reason why you're seeing crazy highs and lows. I suspect the dose is too high and that likely Blackie is going low and then rocketing high from hitting low numbers. Every time you change the dose, especially when you're giving a fairly large dose at one time (3-4units) and then dropping to a small dose the next time - it's like you've set up a crazy dance on the boat.

Lantus works best with consistency. It "likes" to have the doses held for at least 3 days before changing the dose. It works best when shot into lower ranges. It takes a while for it to bring down higher numbers. I think if you looked at other cat's spreadsheets, you would see that high numbers are common. It's not desirable but it's just part of it until a cat gets controlled.

If I were you, I'd drop to 1unit and stick with it for at least 3 days - regardless of how high he goes during that time. Don't let high numbers cause you to panic. LOW numbers are the numbers that are important - and you're not seeing them because of how you are testing and shooting. It can take 3 days for high numbers to clear out of the system if the cat is bouncing from having hit low numbers. That's the reason for waiting 3 days - to see what the dose is actually doing and to be confident about how low the dose is taking the cat. Only shoot less if he gets less than 50 on a human glucometer or 68 on a pet glucometer. Which one are you using?

Did you see my suggestion above that you might benefit from posting in the Relaxed Lantus Insulin Support Group? They could teach you how Lantus works and help you help Blackie.

 

Ok. So if the cat has been on a steady low dose for weeks and weeks doing fine, then suddenly goes way high, do you ignore the high and keep dosing the same anyway? That makes no sense to me. What we should have done at that time was to add in a night dose at that time, with the same dose as the am and ran that for a few days.

That's how this whole mess got started, yes, we were not doing it right.. we should have dropped his dose in the am to 1/2 and given the same dose at pm, instead of nothing. Way back in the beginning, when suddenly he was too low pm to dose, I asked and asked what do I do? No-one answered me, or maybe I didn't see it. So we proceeded to just dose him low in the am and since he consistently tested too low to dose at night, we skipped it. He went this way for 3 months. Then shot up on NOv 25th. I'm not blaming anyone, I'm just trying to explain how we got so off-road with all of this. When he went high Nov 25th, I left the next day to travel back to Portland, OR, to get 50 pounds of Young Again No Carb food for Blackie. I got viciously ill with the flu and ended up staying there for 2 weeks and only my husband was here to take care of him, and he knows very little about Lantus... my mistake. So what should we have done when he suddenly went high that night? Left the dose the same as the morning one I suspect... I so wish we had done that instead of going higher.

I will look at joining the support group.. thank you for the suggestion. You all must get so frustrated and want to reach through cyberspace and shake the crap out of us folks who don't do our due diligence with this illness, and then screw up, sometimes probably even killing our beloved animal friend. I hope I have a chance to recover Blackie from this. I still don't know what to do IF we can get him regulated on low dosage again, and then he starts to spike high again more than for just a day.

I will drop to 1 unit tonight, and 1 unit am and stick with it for several days. I have to try to get him back online again. I just hope it doesn't kill him. He is a tough old guy though, and has lots of reasons to stay with us, so let's hope for the best. Again, thank you for being patient with me.

 

You aren't ignoring the high levels; you are interpreting within the context of how low he goes.
And what you are describing could well be a reaction to an unusual low number triggering compensatory, protective hormones which release stored glucose (glycogen) to bring the glucose up to a safe, survivable level.
Or, a sudden infection could have triggered higher than usual glucose levels. Or the insulin could have pooped out and become less effective.
This is why mid-cycle testing is key. If it is or has gone low, that sup.ports the first possibility. If it is never low, even after 3-4 days, it supports the 2nd possibilities

 

Heidi....When you look up where you've been seeing "0 new messages", this means you don't have any new PRIVATE messages

If you look directly to the right, you'll see "View your posts"...if you click there, you'll see your post and any new replies

If you can get at least 4 tests in per day (Pre-shot as well as 1 mid-cycle during the day and a "before bed" at night) you can start posting in either the Tight Regulation Group OR the Relaxed group

Both groups use Lantus! The Tight Regulation group is where I think most of us are because we are concentrating on keeping our kitties very tightly regulated (between 50-120 as much time as possible) but you can post in either group!

In the TR group, we make changes more frequently (but always holding the same dose for at least 3 days) where the Relaxed group generally doesn't change the dose for 7 days

What you've been trying to do is what we call "beat down" the numbers...think of it like a headache...You think "well my head hurts worse, so maybe I should take 3 aspirin instead of 2"...Lantus DOES NOT work like that!

When you give too much, it could be taking Blackie too low (since you haven't been testing, we can't know) and then his liver reacts to those low numbers by releasing even more sugar and hormones to bring him back up fast! It's a leftover survival mechanism to protect our kitties when they were in the wild and their blood glucose dropped too low. By releasing that stored sugar, it kept them alive long enough to hopefully get a meal!

Next....just because he was doing good months ago on 1 unit doesn't mean his insulin needs won't change....unfortunately, that's all part of this disease. By testing as much as you can and posting in one of the insulin support groups (either TR or Relaxed) those of us that have been using Lantus for awhile can help to tell you when you might need to increase...as well as when you might need to decrease!

Please just hold that 1 unit for 3 days and post daily in either forum and get those tests in.....We really do want to help you with Blackie, but you're going to have to trust us.

Now it would be a good idea for you to get some urine ketone testing in while he's in those higher numbers. This is an extra layer of safety since if they are caught early, ketones can be treated easier...and a lot cheaper. Ketone strips are available at any pharmacy and you just dip them in his urine. We can give you tips on how to do that too.

Come on over to one of the insulin support groups and post...let us try to help you....and then watch that "View your posts" instead of the "0 new messages" above

 

Thank you Chris, for all your good info and advice. We have been keeping the dose the same - at 1.5 actually, (I know, we said one) , but his number are still really high and not dropping much. Just checked midday ... 337 - down 103 points from this am. I guess we'll keep it at 1.5 for another day. I am wondering if maybe he was actually getting better when his number spiked last month? That would explain the spike reaction. Maybe we should stop all insulin for a few days and see what happens? It would rule out the over-reaction from the liver if that is what is happening. What do ya'll think?

 

If his glucose in the +5 to +7 hours post-shot are elevated, I would continue with the dose, and begin following one of the Lantus protocols to adjust the dosing. Tight Regulation does dose adjustments more quickly than Start Low, Go Slow, so if you can test about 4 times a day - pre-shot, mid-cycle, and before bed- I would recommend it. It may help you get better control sooner.

 

I don't think TR is a good fit for Heidi, BJ. She's having a hard time getting midcycle or pm cycle tests, and they are really essential.

Heidi, I would definitely not stop the insulin. Most of the time, increasing slowly and methodically, which monitoring the blood sugar changes that happen while you're increasing, is the path that is needed to get control of blood sugar.

Good job holding the dose for 6 cycles. You're getting the hang of the dosing and we'll be able to tell more because the dose was steady! Lantus likes consistency. If you could just get one pm cycle test every evening, right before you go to bed, we would be able to have confidence in suggesting dosing changes. My gut feeling is that Blackie probably needs more insulin, but i can't suggest increasing without something in the night cycle to let us know how low the dose is taking him. I promise, we don't get a commission for getting people to get a pm cycle test. In fact, everyone here is volunteers - not sure if you realize that. From experience, we know that is critical information to know for every cat because so many of them give all their lower numbers in the pm cycle.

 

Well, it seems even 1.75 isn't going to touch his high numbers. We upped it last night after 3 days, 6pm number - 427 3 hrs later it was down a WHOPPING 6 numbers to 421. This morning - 445. What still baffles me is that his BG steady and low for weeks and weeks with just ONE small dose a day... as the night readings were to high to dose. Then suddenly he starts to climb and climb. I so wish we had given half the morning dose at night in those days... maybe all this would have been avoided. So now we're stuck with 1.75 for 3 days while his numbers don't move hardly at all.

 

Looking at the nadirs you've been getting (above 300) and following the Tight Regulation protocol, it would be OK to increase from 1.5 units to 2.0 units, then hold it for a minimum of 3 days while checking the nadirs.

Initially, you changed the doses so quickly and used different doses based on pre-shots. That works fine with Caninsulin/Vetsulin. It works lousy with Lantus. Lantus is a depot insulin. When you inject it, it forms crystals under the skin. These slowly dissolve to release the insulin. We call these crystals the depot or shed. There are usually some undissolved crystals present when you give the next shot. This results in overlapping shot effects. Lantus works best with the same dose at all shot times, to keep that overlap consistent. Shooting early increase overlap and may act like a dose increase; shooting late decreases the overlap and may act like a dose decrease. Depending on the cat's sensitivity, you want any time adjustments to be no more than 15-30 minutes because of this.

 

I haven't seen anyone else suggest it, but have you considered a different insulin? Most people would be surprised I would say that because I am a very strong proponent of Lantus. But Lantus cannot, just can not be used to in-the-moment beat down high preshot numbers. You can't up the dose after a shot or two, skip, and just do a variation of doses and expect to get any results at all from Lantus. Its a depot insulin and that just won't work. It takes 3-7 days for a dose adjustment on Lantus to settle. If you never consistently dose it twice a day at the same dose for at least 3-5 days, you will never make any progress on Lantus (and you risk a hypo incident). Its like trying to sprint holding a cup of water and not spill any of it. The harder you run, the bigger the waves are in the water. There are non-depot insulins out there. They can work better with the type of dosing you are trying to do. Prozinc and PZI are non-depot insulin yet still longer lasting insulins. Maybe it is time to try one of those? Its so hard to hold the dose when the numbers are high, we all know that, but if you don't on Lantus you can start creating the high numbers instead of helping them.

 

Thanks Melanie. I have to stick with Lantus as it's the only one I can get here in Ecuador. For many months I did hold the dose, etc. It was just in the past month that things got squirrely. We are getting slowly back on track. I have searched the site but can't find any thing so asking what are the signs that a cat may be shutting down? Blackie is back to drinking a ton of water and his breath smells rotten - not normally this way since we started treating his illness in June. I am going to take him in for a tooth exam next week in a town quite a ways away, just in case it is an abscess tooth that started his numbers climbing in November. But in the meantime, is there anything I can do to see if he is actually in his last times? He is eating OK and peeing OK.

 

See my signature link Secondary Monitoring Tools for some other assessments you can make. These will help you evaluate how he may be doing.
Cat Info has a section on dental health - if his mouth is not painful, you could try brushing his teeth.

 

This thread has been quite helpful to me, also. Miles is having many of these same issues. We know how Lantus works but it just isn't cooperating. Good luck with your sweet Blackie, who looks like he enjoys the grass as much as Miles does!